Provider Demographics
NPI:1811254402
Name:SULLINS, DAN JASON (DC)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:JASON
Last Name:SULLINS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17311 DALLAS PKWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1141
Mailing Address - Country:US
Mailing Address - Phone:214-227-7300
Mailing Address - Fax:
Practice Address - Street 1:17311 DALLAS PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1141
Practice Address - Country:US
Practice Address - Phone:214-227-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12047111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology